Big Bill: Largest retraction of health insurance coverage in U.S. history

To date, since WWII, the U.S. has been moving to Expand health insurance coverage, but this legislation is the largest Retraction in health insurance coverage passed to date.

[Updated July 13, 2025] There is a lot more we will need to say about H.R.1, the Big Bill, which the House passed July 3, when they voted on a 218-214 mostly party line vote (with 2 GOP members voting no), and all Democrats voting no.

It is worth noting though that this is the largest RETRACTION of health insurance coverage ever passed in the U.S., the largest assault on the social safety net in history. Since WWII, and especially since 1965, nearly all major pieces of policy passed led to EXPANSIONS of health insurance coverage. The Congressional Budget Office projects 11.8 million will lose Medicaid coverage, and the combined effect of policy changes will lead to an increase of the uninsured of 17 million, according to updated estimates from the CBO.

Putting these changes into context, this assault on the social safety net includes a rise of 17 million in the uninsured between now and 2034 would raise the uninsured to an estimated 43.2 million in 2034, since in 2023 the uninsured was 26.2 million, according to the U.S. Census Bureau (see graph). The total uninsured (all persons) was 45.2 million in 2013 before implementation of the provisions of the Affordable Care Act, according the Census.

Thus the uninsured has dropped 42% since 2013 (before passage of Obamacare), largely because of the creation of the marketplaces and the expansion of Medicaid. A rise of 17 million in the uninsured between now and 2034 would erase almost all (89%) of the reduction in the uninsured since 2013, and raise the uninsured number by 65%. In percentage terms, the uninsured rate was 14.5% in 2013, but dropped to 7.9% in 2023 and would be projected to rise to 11.9% in 2034 using the CBO projections (and this author’s calculations, including estimates of the U.S. population in 2034).

The Paragon Institute makes the same point, that the “key takeaway” is that the combined effects of H.R.1 (the OBBB) and the ending of expanded subidies for the ACA marketplaces “brings spending projections back in line with pre-Biden projections.”

Source: Paragon Institute, "The One Big Beautiful Bill Now Heads to President Trump", July 3, 2025.: